Module Health Psychology Lecture Introduction to Health Psychology

Module: Health Psychology Lecture: Introduction to Health Psychology Date: 19 January 2009 Chris Bridle, Ph. D, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick Tel: +44(24) 761 50222 Email: C. Bridle@warwick. ac. uk www. warwick. ac. uk/go/hpsych

Aims and Objectives n n Aim: To provide an introduction to the discipline of health psychology and the health psychology module Objectives: The student should be able to provide a basic description of the … n nature of health psychology, e. g. who and what are studied n levels of clinical application of/for psychology n pathways through which psychological processes influence physical health n structure and content of the module n module requirements, e. g. tutorial tasks

What is Health Psychology? § Psychology is both an academic and applied discipline involving the scientific study of mental processes and behaviour. § Classic definition: ‘… the aggregate of the specific educational, scientific and professional contribution of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness and related dysfunction’ (Matarazzo, 1980) § Pragmatic definition: Health psychology is the study of psychological processes that influence health, illness and health care

Implications of Our Working Definition Health psychology is the study of psychological processes that influence health, illness and health care n Four questions: 1. In who do psychological processes exert influence, i. e. who gets studied? 2. What types of psychological process are studied? 3. How do processes influence health, illness and health care? 4. In what ways can psychology be applied in clinical practice?

1: Psychological Processes in Who? n People who receive health care n Patients: anyone interacting with a health care professional or service n n n People who provide health care n n n Users: perceived presence of symptoms driving health care use Consumers: active, and proactive, care seeking by the asymptomatic Providers: professional responsibility to provide care directly to patient Carers: as above, but without professional responsibility People who organise health care n n Purchasers / managers: who fund and evaluate local service against benchmark quality indicator, e. g. treatment targets Policy- / Decision-makers: set national-level quality indicators, provide clinical guidance and allocate financial resources

2. Processes Studied in Health Psychology § Multiple developmental influences, in particular § Behaviourism § Social Psychology § Cognitive Psychology

Behaviourism n n The scientific study of how reward and punishment (stimuli) affect emotion and behaviour (response) Empirical approach: Vary contingencies of reward and punishment and measure effect on behaviour n Try to explain all behavior without going inside the ‘black box’, i. e. the mind n Behaviour is a conditioned response occurring in the presence of a stimuli n Operant conditioning (Skinner) Classical conditioning (Pavlov) If behaviour is learned, it can also be unlearned / modified through conditioned learning Classical conditioning (Watson)

Behavioural Conditioning A Clockwork Orange Alex given drug to induce extreme nausea (response) whilst also being forced to watch graphically violent films (stimuli) for two weeks At treatment end, Alex is unable to even think about violence without crippling nausea, e. g. conditioned response in presence of the paired stimuli Fiction or reality? This is an example of classical conditioning, and describes the use of aversion therapy. Addiction believed to have its roots in conditioning, e. g. positive stimuli associated with consumption of food, alcohol, drugs, etc.

Social Psychology n n The scientific study of the way in which people’s thoughts, feelings, and actions are influenced by the social environment Empirical approach: Vary aspects of social environment and see how this affects thoughts, feelings, and/or behaviour Posit psychological processes as explanations for observed effects Classic examples: Obedience

Milgram’s Obedience Study n Pain-induced learning (Milgram, 1963) n Procedure: A study about ‘learning’ n n n Ask questions to another ‘subject’ in the next room Authority figure instructs subject to administer increasing ‘shock levels’ in response to wrong answers Question: How obedient will people be? n Obedience measure: Shock level administered n Levels: ‘moderate’, ‘strong’, . very strong’, ‘intense’, ‘danger–severe’, ‘XXX’

Obedience § Result: 65% administered highest shock level § Interpretation: Perceived legitimate authority facilitates obedience ‘The ordinary person who shocked the victim did so out of a sense of obligation - an impression of his duties as a subject - and not from any peculiarly aggressive tendencies. ’ (Milgram)

Obedience in Health Care? n Drug administration n n Result: n n Nurses asked, by Dr on phone, to give patient a nonprescribed and incorrectly dosed drug 21 / 22 administered the drug Interpretation: n Perceived legitimate authority facilitates obedience (Hoffling et al)

Cognitive Psychology § The scientific study of basic mental abilities § perception, learning, memory, language, problemsolving, etc. – ‘information-processing approach’ § Empirical approach: Vary information input, measure performance output § Posits psychological processes that account for observed effects § Classic examples: Stroop Effect

Stroop Effect n n Name the colour of each block: Start top left, work down and then across Two measures: (1) response/reaction time, and (2) errors Easy? n Quick time? n No errors? (Stroop, 1935)

This time – coloured words instead of coloured blocks n Name the colour in which the word is written n e. g. ‘table’ the answer / response would be ‘yellow’ yellow white pink grey black orange yellow purple orange green tan red green purple grey orange pink black orange white yellow Not so easy? n Took longer? n Didn’t finish? n More errors? Answered ‘yes’ to 1 or more above? That makes you . . … NORMAL (Stroop, 1935)

n Stroop Effect n n n Result: Fewer errors and faster time to name color alone than in presence of word written in conflicting colour Explanation: Presence of conflicting colour word interferes with processing ability / task performance Conclusion: The meaning of a word is processed automatically, without intention

Social Psychology + Cognitive Psychology = Social Cognition

Social Cognition § The scientific study of how people make sense of their social world: § § § How they perceive, represent, interpret, and remember information about themselves, others and social groups Information processing in its social context Key question: Is the combined total more than the sum of its parts? What does social cognition offer over and above the contributions of social and cognitive psychology?

New methodologies: Stroop & Person-perception Race of Person Caucasian (White) African-american (Black) W Colour Of Ink B (Karylowski, et al. , 2002)

New methodologies: Stroop & Person-perception Race of Person Caucasian (White) African-american (Black) W Match Mismatch B Mismatch Match Colour Of Ink (Karylowski, et al. , 2002)

New methodologies: Stroop & Person-perception Race of Person Caucasian (White) African-american (Black) W Jerry Seinfeld Oprah Winfrey B Rosie O’Donnell Bill Cosby Colour Of Ink (Karylowski, et al. , 2002)

n n Result: Slower to read ink colour when colour and racial category mismatch than when they match What do these data actually mean? Racial categories come to mind automatically (Karylowski, et al. , 2002) Reaction Time (ms) Stroop and Person-Perception Ink Color

In the Health Context § Social categories are activated automatically during interactions with other people § Interactions and decision-making potentially influenced by stereotypic beliefs and biased knowledge § Helps us understand evidence showing that, for certain social groups, clinicians … § offer less information, less support and are less clinically proficient § provide different treatments, preventive interventions and referral to specialist services

3. Psychology and Health n Dual Pathway Model: Two broad ways in which psychological processes may influence physical health Psychological Processes Physical Health Direct Path In h di re t a P ct P at r t c e h Behaviour i d In

A Primer n Psychoneuroimmunology (PNI) n n n Lutgendorf & Costanzo (2003). PNI and health psychology: An integrative model. Brain, Behavior and Immunity, 17, 225 -232 Glaser & Kiecolt-Glaser (2005). Stress damages immune system and health. Discovery Medicine, 5, 165 -169 Antoni et al. (2006). The influence of bio-behavioral factors on tumour biology: pathways and mechanisms. Nature Reviews (Cancer), 6, 240 -248

Nervous System: Physiological Reactivity Hormones Psych Processes GI: IBS, ulcers C h St ro re ni ss c Nerves Psychological Appraisal Psych: cognitive decline, morbidity RS: impotence, amenorrhea Endocrine System olic n b a Met nctio fu dys Sensitivity more severe Re. S: asthma, hyperventilation Cardiovascular System Essential Hypertension Physical and Psychological Health Status Salient Event Immune System Lo im were mu d nit y Hy - m pe r or vig e ila ev n en ce ts

4. Clinical Application § Three basic levels at which psychological principles (knowledge and techniques) can be applied: § Awareness of patient’s psychological state § Knowledge of basic psychological issues relevant to context (e. g. condition), patient-centred communication § Intervention in the form of brief counselling § Emotional care, motivational support, behavioural advice, informational and educational care § Therapy from relevant psychological therapist § Knowing when and where to refer, screening for ‘caseness’, engaging in/with a care team, follow-up, case management, etc.

Module Aims / Objectives § Block 1: Before § to conceptualise the interplay between biological, psychological and social factors in health by considering core psychological constructs underlying health-related behaviours and beliefs. § Block 2: During § to appreciate and consider the use of core psychological constructs to facilitate positive consultation outcomes. § Block 3: After § to recognise the importance of considering post-consultation consequences in the context of ongoing patient care § Block 4: Consolidation § to provide opportunity for structured supported revision and consolidated learning.

Module Content Lecture Assumption Health psychology Tells us what we already know but in a language we can’t understand Health behaviour and beliefs People will protect, not damage, their health if they know the facts Illness behaviour and beliefs Patients consult when they think they are ill, and adhere to advice Consultation They get ill, we consult, I treat, and they get better – simple Preventive medicine Patients willingly engage with & benefit from preventive protocols Psychological medicine Weak medicine for weak people – a waste of time and resources Addiction, change & relapse A social problem with an individual solution – just say no, or stop Stressful medicine Patients are content when referred to an expert for specialised care Chronic illness & somatisation Challenging patients – no, more like challenging patience Revision session Students welcome the opportunity to consolidate their learning Question and answer Students will consider course material & formulate sensible questions Bank holiday Self-directed learning

Structure Time Mins 1345 – 1500 60 – 75 - 15 – 30 Self-study 1515 – 1645 75 – 90 Tutorial* 1515 - 1645 75 – 90 Lecture Break * Weeks 3, 6 and 9

Requirements n The module is a core module that must be completed satisfactorily in terms of: n n n Attendance at both lectures and tutorials is compulsory Assessment, which may include both written ESAs and OSCEs Participation, including the completion of required reading and tutorial tasks

Tutorial Tasks n Student-led tutorials involving 4 small-group (4 -5 students) presentations, each with two components: n n Integration template: students will select a clinical condition and identify (from the lectures in that block) the psychological factors relevant to the condition Formative questions: students will develop ESA questions (1 per group per tutorial The template and ESA questions will be presented to other students for critique and evaluation Example ESA questions will be n n made available to all students formative assessment / revision purposes at the end of each block submitted to the WMS ESA question bank

Integration Template Example: Back Pain Learning Domain Knowledge, Skills and Abilities 1. Science: Basic / Clinical Anatomy of the spine / Effect of spinal cord injury at different levels; Radicular syndromes Psychological Biopsychosocial models of disease, pain, self-management; Gate theories of pain; PNI link between pain and depression Aetiologic/Pathologic Accidental injury / Pathology of spine disease – disc disease, spine infection, ankylosing spondylitis Social / Ethical Loss of work; Disproportionate use of scarce resources; Social isolation; Learned helplessness; Treatment of pain 2. Diagnosis Symptoms / Signs Back pain/stiffness; Radicular syndromes; Back deformity Skills / Investigation Screening MS examination; Detailed regional MS and neurologic examination / Basic haematological tests; X-rays; MRI 3. Management: Therapeutic skills Treatment of chronic diseases; Psychological pain management; Medication / Operation Simple analgesics; NSAIDS / Indications for operation Rehab / Follow-up Musculoskeletal/occupational therapy / Stepped care; Timelimited treatment with follow-up from referral Prevention/Pub Health and Safety; Workplace educational programmes; Injury prevention

Additional Information Module Leader: Chris Bridle Office: A 0. 22 Medical School Building Telephone: Email: Webpage: (024) 761 50222 C. Bridle@warwick. ac. uk www. warwick. ac. uk/go/hpsych n n Module staff: n Each tutor available to meet at the end of each tutorial n I will be available to meet at the end of each lecture Office hours: n I have an open door policy – please don’t abuse it.

Conclusions n This session would have helped you to understand the … n nature of health psychology, e. g. who and what are studied different levels of clinical application for psychological principles dual pathways through which psychological processes influence physical health n structure and content of the module n module requirements, e. g. tutorial tasks

n What now? n n Familiarise yourself with the module webpage Obtain / download one of the recommended readings Organise yourselves into small groups (re: tutorial tasks) Consider / select a condition on which to develop your integrated template Any questions?